I am honoured to have been asked to come and speak with you today on a subject that is a true passion of mine – the power of partnership and collaboration. What I’ll take you through today are my thoughts on:
• the changing landscape of the research and university sectors and the need for a new approach if we are to remain relevant
• the power of collaboration, from my own experience and that of others
• the imperative of a new mindset if we are to make Sydney one of the great biomedical and health centres of the world and how the onus is on all of us to make that happen
• the Sydney Partnership for Health, Education, Research and Enterprise – or SPHERE as it’s known – and some of what has already been achieved by its Clinical Academic Groups, and
• the future of education, healthcare, research and innovation and what successful collaboration will look like for staff and students in 5 or 10 years’ time.
The greater good
St Vincent’s Health Australia is a name synonymous with excellence in education, healthcare, research and innovation.
Those attributes are writ large in your work and in the successes of the Institutes with which we jointly partner – the Garvan, Victor Chang and Kirby – where great advances have been made across many fields of medical endeavour.
I’d like to take a moment to send our admiration and very best wishes for a return to full health to David Cooper, a UNSW Scientia Professor and inaugural Director of the Kirby Institute.
Professor Cooper has worked tirelessly to serve the Darlinghurst community – and, through it, the broader community. He has had a global impact on the understanding of the AIDS virus and on its containment.
The Kirby Institute, and all of us, have indeed been fortunate to have the brilliant mind and boundless passion of David Cooper at our service.
Many owe him a debt of gratitude, and our thanks and our thoughts are with him today.
David has always respected, as we all do, St Vincent’s commitment to honouring the legacy of its founders.
The Sisters of Charity may have been staunch Catholic women, but they believe in ‘need over creed’.
Their devotion to the service of the poor is indeed noble and commits them to serving the greater good.
And that ideal, of serving the greater good, is the very characteristic that underpins collaboration.
Being willing to surrender sole ownership – of anything – to achieve a higher goal, acknowledges that some things are more important that individual glory.
Serving something greater, seeing something greater and striving for something greater forms the core of the St Vincent’s Health Australia EnVision 2025 Group Strategy.
That same sentiment is the foundation of UNSW’s 2025 Strategy, which is unapologetically bold, ambitious and, above all, altruistic.
If I could sum up its overriding theme it would be ‘people, people, people’.
Ultimately, our commitment to quality education, to innovation and to collaboration – across disciplines, across institutions and across industry and government – will serve people right across the globe.
Universities must view their place in the world, as servants of the local, national and global community.
To do that, we must stay relevant and in touch with the needs of the community we serve. The Ivory Tower mentality will not be tolerated in 2018.
If siloed thinking remains, we not only risk duplication and wasted time, effort and money, but what may be irreversible damage to our collective reputation.
While it can be hard to measure collaboration in monetary terms, there is no doubt it can add the equivalent of a capital injection.
As far as the power of generosity in partnership, my view is that the long-term return is always more than you give.
Just look at one of the greatest public health campaigns of our lifetime – the eradication of polio.
The story began back in the 1950s with Jonas Salk, whose devotion to the greater good was famously immortalised in his ‘could you patent the sun?’ quote. And, yes, there was certainly collaboration with President Roosevelt throwing his weight behind the March of Dimes.
But when Albert Sabin developed the oral vaccine, it was the catalyst for a global collaboration from unexpected quarters:
• national governments
• the World Health Organisation and the United Nations
• Rotary International
• the Bill and Melinda Gates Foundation
• the general public
• and even warring factions who call a truce on World Polio Day to allow volunteers safe passage to administer the vaccine.
The result has been a 99.9% reduction in worldwide polio cases since Rotary’s first project in the Philippines in 1979.
Academic Health Science Partnerships
I have seen collaboration work to powerful effect through my involvement in Academic Health Science Partnerships.
I had the privilege of helping establish UCL Partners in London and of leading the Manchester Academic Health Science Centre. I saw both drive changes – that were beyond expectations – in medicine, education, healthcare and innovation.
The work in both London and Manchester with stroke is a good illustration, of which many of you will be aware.
I, in fact, witnessed this collaborative success story in action.
A year after I arrived in Sydney, my father-in-law in the UK had a massive stroke.
He was taken by NHS ambulance and helicopter to a specialist centre and within 45 minutes had thrombolytic therapy.
He was sitting up in bed 24 hours later instead of being in a wheel chair or dead. A year after that he was visiting my wife and me and enjoying the beaches of NSW.
I will let you in to the secret though. The NHS is not that great – he had the stroke as a result of waiting for over six months for elective treatment of atrial fibrillation.
I’m also aware now of the NSW Health System’s reforms that have achieved major improvement in best evidence stroke care delivery. These reforms were also driven by AHSPs and in fact predate the Manchester reforms.
Best care in stroke requires strong links in a chain of survival and better outcomes.
Traditionally, the key links in the chain were disconnected with an Ambulance Sservice, an Emergency Department, a Radiology Department, and a Stroke Unit all operating in silos.
When evidence emerged that time is of the essence in achieving good outcomes for stroke, researchers in NSW devised a number of health system reforms which they rigorously tested in clinical trials which brought all the elements together in partnership.
The National Stoke Foundation was also engaged to drive public awareness improvements.
The upshot of this work was a complete redesign in pre-hospital and emergency stroke care – initially rolled out in the Hunter Region and then across Sydney and the rest of NSW.
These reforms have led to major impact on the proportion of stroke patients accessing best evidence care and thereby improved outcomes.
Now in NSW, those assessed as having a stroke are taken to one of 19 hyper-acute stroke units across the state.
Now, in 2018, we’re faced with adapting systems of care to deliver on new evidence or mechanical treatment, so called endovascular clot retrieval.
Once again, an AHSP is forming to streamline systems of care and research better ways of delivering this intervention stroke treatment.
Without partnership this work would not progress.
The Hunter Medical Research Institute has done some modelling on the economic benefits of stroke prevention and treatment – and I have figures which are hot off the press.
The health economic impact of intervention modelled a $4 million-plus saving over a 12-month period in the Hunter Region alone. Across NSW that figure is around $72 million per year.
Such ongoing and significant benefits to society, and to the economy, are a good argument against those who balk at the short-term cost of research.
It is an argument we all must continue to make, especially in an era of tightening government budgets.
Collaboration
Major advances in healthcare, like that with strokes, simply cannot come from a researcher sitting alone in a lab.
They will only come when need intersects with the knowledge that sits within – and between –fields of expertise, and with each allowed to play to their strength.
The unity of purpose is incalculable.
As Japanese author, Ryunosuke Satoro wrote, ‘Individually we are one drop. Together we are an ocean.’
No doubt, pressures and priorities can lead to tension between, for example, Medical Research Institutes and universities.
I have taken the view that those tensions can be overcome by the combination of a shared overall vision, a commitment to partnership and careful attention to strategic alignment.
Strategic alignment allows organisations such as MRIs, universities and LHDs to co-invest and share the credit for funding awards and outputs, such as publications, whilst remaining independent – a win-win situation.
CIMIT in Boston and MIMIT in Manchester are excellent examples of how linking various players in an AHSP accelerates innovation and fosters the discovery, development, and implementation of innovative healthcare.
The premise is reverse engineering. Identify the need and harness knowledge and expertise within the partnership to develop technologies, devices or therapies to address it.
Of course, St Vincent’s is not new to the consortium space. It has been at the vanguard of Health Science partnerships for decades.
The tight geographic alignment of the clinical and academic worlds here in the Darlinghurst precinct has led to a proud history of bridging biomedical research and clinical care.
But the landscape is shifting at such a pace and scale, that we need to keep asking ourselves if our way of thinking is agile and open enough to keep up.
This is not something to be feared. It may be the disruption we need, particularly right here in Sydney.
The great biomedical and health centres of the world are characterised by high quality Academic Health Science Centres – bringing together universities, hospitals, research institutes, public and primary care.
They greatly enhance the health of their population, produce advances which have a global impact and bring enormous economic benefit, creating jobs, health and opportunity.
Even before arriving in Australia, I pondered the reason why, despite many undoubted top-quality components and people, Sydney is not seen as a world-leading centre of biomedical and health excellence.
It is seen as running behind Melbourne, arguably 3rd or 4th in Australia, and not a major player on the world stage.
I believe that Sydney can and should be recognised amongst the 10 leading centres for health care, health research and health education worldwide.
To my mind, a relentless, determined commitment to adding value by breaking down silos and the barriers to effective partnering and collaboration has been the missing link.
What else can explain it?
We have here top-class universities, a wonderful healthcare system, numerous individual experts, an open, egalitarian society, and a stable economy.
Add to that, its other features – iconic architecture, its international reputation as a business hub, and a culture and climate that make it one of the most enviable locations on earth.
We have people in Sydney who are doing good work – some on dementia, some on cancer, some on genetics, and the list goes on.
But the many brilliant, individual drops have not yet formed a deep and powerful ocean.
And until that happens, we will not attract and retain the best people.
And unless we attract, retain and inspire the best people – who can tap into the best networks and infrastructure – we will not produce the best outcomes nor capture the attention of industry.
We have to find a different way of working together, through sophisticated, committed and determined collaboration in a top-quality Academic Health Science Partnership.
That is the responsibility of the leaders across all our organisations – to drive this change to bring the benefits to our population – and I believe we are well on our way.
SPHERE
That is where the Sydney Partnership for Health, Education, Research and Enterprise, or SPHERE as it’s known, comes in.
SPHERE has also been gifted an Indigenous name ‘Maridulu Budyari Gumal’ which in the language of the Dharug people means ‘Working together to promote better health and wellbeing’.
The name describes perfectly what SPHERE is about and also acknowledges our strong commitment to the Aboriginal community.
I have had the enormous privilege of developing and then chairing this partnership which brings together organisations that share a commitment to collaboration across research, education and the delivery of healthcare services.
SPHERE also links modern healthcare with university and institute partners in science, engineering, design, built environment, business and law.
It serves over two million people in the fastest growing population in Australia – a geographic arc stretching from the Liverpool plains to Bowral, across to Coogee and through St George to the CBD.
A region home to many Indigenous people and refugees and some of the most, culturally diverse and disadvantaged people in our nation.
The rationale for SPHERE was to deliver a step-change in the translation of excellence in research and education, into outstanding healthcare in our region.
It is a NSW-first collaborative initiative bringing together 14 leading health partners in the Sydney region:
• Two Local health districts which involve more than 10 hospitals and health organisations as well as key links to primary care
• Two Health Networks: St Vincent’s Health Network and Sydney Children’s Hospitals Network
• Three universities: UTS, UNSW Sydney and Western Sydney University
• And seven Medical Research Institutes, including Victor Chang Cardiac Research Institute, and the Garvan Institute of Medical Research.
Critical to its success is the strong governance structure for this partnership, which brings together – in the form of a SPHERE Council – Directors, CEOs, Chairs, Deans and Vice Chancellors.
And I must acknowledge the SPHERE Council.
It is made up of the most impressive group of leaders I have come across in my 30 year career in medicine and academia in the UK, USA and Australia.
I can’t mention all of them, so I probably shouldn’t mention any, but I see several in the audience and cannot resist the opportunity to thank them for their outstanding leadership – [if in audience Anthony Schembri, John Mattick, Bob Graham, Terry Campbell, Philip Cunningham]. To anyone I missed, I assure you, you are no less valued.
The collegiality of the Council during the two-year set-up phase set the tone for SPHERE’s collaborative aspirations.
I cannot stress enough the importance of leadership – at all levels of all the partner organisations – in the success of such a partnership.
Alignment of purpose and leadership are two sides of the partnership coin which has enabled deep collaborative efforts from across our organisations.
One unique aspect of this initiative was the early agreement from each of our partners to invest seed funding in the partnership – totalling $20 million over five years – to incentivise and drive new behaviours.
We plan to leverage much larger sums from industry, philanthropy, government and grant funding agencies and have already achieved a greater than 10% return on our investment.
The financial commitment from our partners has been powerful in encouraging clinicians and academics to work together across geographical, disciplinary and institutional boundaries.
The SPHERE Council committed a total of $6m over 3 years to support the establishment of the 12 Clinical Academic Groups, listed on the slide, which were chosen from 27 submissions.
I am full of admiration for the way the CAGs came together. The SPHERE Council did not direct their establishment. We invited clinicians and academics to come together in whatever groups they felt were best to deliver the SPHERE vision.
The accreditation of the CAGs was intense and followed a robust process but was successful because the NHMRC was so impressed with the way we had set up the partnership.
Accreditation is a great achievement in itself and we are eager to hear from the CAGs in July about their specific achievements.
CAG achievements
And they already beginning to deliver and add value in ways that were not previously possible. And I applaud the hard work of all involved.
I’ll give you just a few examples.
The South West Sydney Samoan Community is participating in the SPHERE Diabetes, Obesity and Metabolic Disease CAG research program. A visiting international minister remarked on how well the members of the congregation were looking and encouraged them to continue their good work with SPHERE.
Our Maternal, Newborn and Women’s Health CAG is making great gains in upskilling our staff on Implementation Science, in partnership with Kings Health Partners from the UK.
Prof Sandy Middleton from your own Nursing Research Institute here at St Vincent’s has agreed to lead this initiative for SPHERE as part of the Implementation Science and Knowledge Translation Strategic Platform.
At the Age and Ageing CAG Planning Day held this month, it was agreed by those present – clinicians and academics – to extend invitations to St Vincent’s and UNSW’s age and ageing experts to participate and potentially lead key projects.
I want to emphasise this because it is a collaboration milestone.
The only ARC Centre of Excellence in Ageing is at UNSW and yet, it has never collaborated with the St Vincent’s experts just a few kilometres down the road.
I congratulate all who have taken that first step in linking health to the power and strength of broad-based universities like UTS, WSU and UNSW.
There will be another targeted call for new CAGs to start in 2019, after the 12 foundation CAGs have presented their Performance Review in July 2018.
This will be an opportunity for groups of experts in areas of strength from across SPHERE Partners. And I would hope Cardiovascular might be one of those.
St Vincent’s has, of course, strong representation across the 12 Clinical Academic Groups.
What I would like to do now is take a few minutes to explain a little more about how we’ve set SPHERE up.
Strategic platforms
In addition to the SPHERE CAGs there are Strategic Platforms that will present opportunities for others within your business to participate.
For example:
• Innovation: encouraging new ideas from your frontline people
• Clinical Trials and Patient and Public Involvement: There is already significant progress on this platform into which I am sure St Vincent’s will be able to contribute and drive. And I understand you have just completed a scoping study for clinical trials.
• Supporting Leading Better Value Care: Anthony has already provided some initial feedback to Prof Chris Levi, Exec Director of SPHERE, about how we should move forward to best support St Vincent’s activities.
• Health Informatics: Our focus here will be on aligning our routinely collected health data, data literacy and identifying international standard data sets for each of our CAG projects.
• Implementation Science & Knowledge Translation: As mentioned, Prof Sandy Middleton from will lead part of this initiative and Prof Katharine Boydell from the Black Dog Institute will lead the Knowledge Translation part and I look forward to hearing from them at the April SPHERE Council meeting. We have charged both of these experts to design activities that will set SPHERE apart from its peers and engage the community more broadly in our activities.
Separately, SPHERE is committed to building capacity and capability across our clinical research workforce.
I believe we are currently investing in the establishment of SPHERE Advanced Trainee Fellowship, SPHERE Nursing & Midwifery programs in conjunction with the NSW Chief Nursing and Midwifery Office as well as identifying programs to build capacity within and across the Allied Health workforce.
Each of these strategic programs and platforms will be assessed to determine their impact, using a range of different metrics, thus positioning SPHERE as a Partnership that is focused on achievement and change.
At its essence, SPHERE is an enabling platform for programmatic collaboration vs the ad hoc style we’re used to.
But it is also disruptive in that we are asking for outcomes and impacts within timeframes.
For this reason SPHERE has reached into the Business Schools within each of its academic partners to identify suitable and relevant methods of evaluating our success.
We, as researchers, understand the need for academic freedom.
But we, as residents of the 21st century, understand that doing things the way we always have is not an option.
There is a need for haste and there is a need to measure outcomes and impact.
The Clinical Academic Groups must deliver.
We are still learning and fine-tuning SPHERE.
I think one area we can improve on is in engagement between the CAGS so we can get better alignment at a leadership level.
Especially given our CAGS are collaborating with primary care, public health and agencies focused on prevention.
Any shortfall in alignment or leadership can result in CAGs dropping behind schedule and therefore not meeting KPIs by performance review time.
Having said that, there is a healthy competitive spirit developing between our Groups.
I say it is healthy because the competition is not for money, all CAGs receive the same seed funding from SPHERE. The competition is for achievement.
What we are asking for here is bold and ambitious but if you think about Age and Ageing, for example, there is a sense of urgency.
We have the looming prospect of a population heavily weighted with those with more – or greater – health issues. On the other end of the scale, we have fewer people of working age making significant tax contributions.
If we do not find ways to improve the quality of life of older Australians, the stress on the health and aged care systems will be enormous.
And yet, at SPHERE, we believe every area we’ve identified should be approached with a desire to solve problems faster.
That can happen without our work losing any integrity, it is just about being better at finding the right linkages.
At SPHERE, we are already collaborating with other leading centres in Asia, Europe and North America and our university partners are recruiting outstanding academics from overseas.
This has been aided, of course, by geopolitics – Brexit, US politics, and the growth of Asia which places Australia and Sydney centre stage of global developments.
The future of SPHERE is exciting with everything we have planned, including major investments of over $2 billion in facilities, precincts and our people.
This is a long-term venture.
And I’m very pleased to say that our model is now being considered by other national Centres, some established for much longer than SPHERE.
Importantly, in the spirit of partnership we are also in discussion with Sydney Health Partners which is made up of the Sydney Children’s Hospitals Network (Westmead); the University of Sydney; and nine affiliated independent medical research institutes.
We’re exploring ways of working together for our community and to project this great city nationally and internationally. I see that as a way to quickly outshine Melbourne and establish Sydney and NSW as a world-leading biomedical and health hub.
There is no grey area. Our networks must become geographically and intellectually borderless.
And we cannot discount collaboration with any field of study or research in our quest for answers.
Unconventional collaboration
At UNSW, we’re seeing collaborations between medical research, technology and design that we may not have perceived of 10 years ago.
EPIcentre is co-located at our Art and Design Paddington Campus and that alignment has brought us next generation medical visualisation.
A fibre optic cable links EPIcentre to our global research networks and partner institutions of Imperial College, London; University of Illinois; University of California, San Diego; and Monash University.
We have huge volumes of data being run through unconventional algorithms to give ultra-high resolution, interactive and immersive 3D visualisation.
It can simulate experiences of dementia, psychosis or memory loss, for example.
You can see, hear and experience the world from the perspective of an elderly dementia patient, a teenager with mental health issues or a child with autism.
It is powerful tool in developing understanding and empathy – and that must not be underestimated as we seek to improve the health care journey for patients.
This was brought home to us at our inaugural SPHERE conference last November.
We asked our colleagues at the National Institute of Dramatic Art, to develop and present a play about the journey of a cancer patient.
It depicted how confusing, bureaucratic, insensitive, heartless or downright rude the health system can be for a person. It was confronting but incredibly powerful.
It moved patients, patient advocates, clinicians and academics in the room to such an extent that a commitment was made to explore the idea of patient ‘navigators’ – people who know the system, can speak the language and can prepare patients for what is ahead.
SPHERE has already started to investigate options and I am sure St Vincent’s will have experts who can contribute and participate.
We had no agenda in showing that play. We sought no outcome from it. We just knew that it would allow our delegates to get insights into the way their interactions impact a person at their most vulnerable.
It was a perfect illustration of how times are changing for collaborative research and how new ideas can come from working together.
The whole conference was a success and will be repeated in 2019 in partnership with Sydney Health Partners and NSW Regional Health Partners and I encourage you to come along.
Embedded research
If we ever needed support for the benefits of researchers and healthcare being in close proximity, it came in the form of Simon McKeon’s Strategic Review into Health and Medical Research in 2013. The report stressed the importance of embedding research into healthcare.
In an article McKeon wrote for The Conversation, he said an overarching message of the report was that embedding research ensures government investment ‘benefits all Australians – through better health outcomes – and delivers the greatest economic value’.
He went on to write that ‘the growing pressure on health services has restricted research activity in the health system…’ and…’has also created barriers for research translation into evidence-based clinical and health interventions’.
I agree wholeheartedly.
It is why UNSW is delighted that the Randwick Health Precinct is progressing.
The precinct will see health infrastructure in the area vastly improved.
It will also create a uniquely integrated hospital-university campus, linking all aspects of work at UNSW Sydney with healthcare services in the LHDs on a seamless campus stretching from Anzac Parade to Avoca Street.
Our health staff will be interacting with academics from science, engineering, law, business, arts, design and built environment as well as medicine. None of them will be more than 10 minutes from each other – a cauldron of talent, expertise and opportunity.
A new acute adult services building will be built; a children’s hospital; there’ll be a new emergency department; extra beds; new operating theatres; and expanded rehabilitation and ambulatory care facilities.
We have also completed a Master Plan for a dedicated mental health precinct.
The opportunity to achieve this level of seamless physical and working integration between the hospital and UNSW will help us compete at the forefront of international health research and education.
Add to that the potential at the heart of this for an innovation hub bringing in start-ups, pharma and major industry partners to drive the innovation pipeline.
A physically integrated Randwick Health and Education Precinct is something that has been on the drawing board for more than 50 years and UNSW Sydney is proud to partner with NSW Health to make this project a reality.
It is not just in Randwick that there are grand plans.
We are also on our way to building the first cancer Wellness Centre in South Western Sydney, in partnership with Western Sydney University, the Ingham Institute and the National Institute of Complementary Medicine, and Liverpool Hospital Cancer Services.
And St Vincent’s has exciting development plans which I believe will soon be in the public domain.
The future of collaboration
So, what will it mean if we are part of the generation that brings true collaboration to the research, healthcare, education and innovation sectors?
What will it mean for staff and students in 10 years from now?
For one, we won’t be aware of it happening. It will just happen.
Perhaps all of our 50000 staff will be using their my health record because they understand how data helps improve their care.
Perhaps we will have a string of innovations with origins in the health services generating wealth and reducing the current spend on healthcare.
Perhaps all of the Healthcare providers who serve our population embrace national and international best practice, resulting in a reduction in unwarranted clinical variation across all of our hospitals and community health centres.
For industry, it might mean " just in time" delivery of research outcomes, to a highly educated workforce, engaging with providers of services and materials to ensure no one is left behind in the way we deliver healthcare.
The current industry complaint about the difficulty in doing business with health services should dissipate, especially if our Institutes and Universities help by building safe and comfortable spaces for industry and health to partner.
Conclusion
Disruption is happening, it is inevitable and it should be seen as an opportunity.
We can achieve unimaginable leaps and bounds in healthcare, in education, in research and in innovation – if we totally embrace the ideal of working for the greater good.
When you work for what is right rather than what is best for you or your career or your institution, you work with far greater passion and conviction.
I wish you well with this, your first St Vincent’s Health Australia research forum. And I look forward to continuing – and furthering – the wonderful partnership we have enjoy.
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